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I've always had right knee pain during the riding season. Yesterday I went out for the first time in a few weeks because of nasty weather. Anyway I concentrated on my form and noticed my right knee doesn't track straight up and down like a piston, but rather it moves a little side to side. I'm certain this is causing my pain. I know my right leg is shorter than my left and I have lemond wedges under my cleats to try and level my legs. It's not as simple as just don't let your knee go side to side. Obviously that'll be part of it. What else can I try? I just use the normal insoles from sidi. Is this a case where someone would try different insoles? I have a low arch.

I am not a fit expert but I do know that a fitter would need quite a bit more information before he/she could answer this question. Based on the knowledge you are using wedges and know that you have a leg length discrepancy I am assuming you have had a professional fit in the past.

When was the last time you had your fit reviewed? It is recommended to be refit every year and after the purchase of a new bike or the addition of a new bike.

The reason for the refit/fit review each year is because we all change physiologically. Flexibility, strength, injury all play a part in making the decision to get refit.

Alignment issues will affect knee tracking on the bike. BTW significant leg length difference is rare, it is more often (hip?) alignment issues.

I have three Specialized wedges in each shoe, orthotics, have rotated by cleats slightly and I use time pedals due to the float. Most of my knee problems have now gone. I use Shimano Shoes, but Specialized shoes (1Deg angle built in) + wedges + insoles my help you.

So you fired on a full custom Ruegamer with ridiculous components and haven't even gotten a fitting from a top notch fitter? The insanity....

Most people have mild length discrepancies that don't require spacers and the only way to accurately find them is through x-rays (Retul can help a bit if they're big enough). You most likely have a cleat spacing (side to side) AND/OR (most likely and), wedging issue. I had the same problem and added another wedge. I run two varus wedges per foot, moved my cleats in and I put in some Specialized red insoles. Had Retul done and this turned out to be perfect. My foot was collapsing outward on the downstroke giving me the false impression that my leg was straight, when it in fact was bowing outwards because I didn't have enough medial and inner support.

KWalker wrote: I run two varus wedges per foot.... My foot was collapsing outward on the downstroke giving me the false impression that my leg was straight, when it in fact was bowing outwards because I didn't have enough medial and inner support.

Same symptom and same method of resolution for me.

But you will need to see someone that knows what they are doing or you could in for a world of pain.

KWalker wrote:So you fired on a full custom Ruegamer with ridiculous components and haven't even gotten a fitting from a top notch fitter? The insanity....

No... I'm talking about with my TIME. I've had knee pain with this setup from the beginning and I was fitted by supposedly one of the best fitters in my area (even recommended by other forum members). I know the frame is too big, which is some of the problem so I'm interested in seeing the change with my Rue. I should have mentioned the frame was too big in the original post, but i wanted to hear people's responses before instantly just jumping to the sizing issue, which i agree is most like the problem. I want to still use this frame and thought with some insoles or wedges I could make it work. Had I just mentioned the frame size, all I would have gotten was 'get a new frame'.

Rue designed my new frame with a shorter top tube length and overall geometry. She required the typical measurements that all custom builders do (body and current frame) and about 50 pictures of me on and off my bike in various positions and placements. I went thru the initial stages of several custom builders and I was most impressed with how detailed and involved her initial work up. The first thing all of the custom builders said was that my TIME was too big. Lol so much for that professional fit. Bre sent my photos all marked up with how I should be and what position would provide me the most comfort and power. It's funny because as I ride my TIME (waiting for my Rue build) I can 'mentally' feel the difference that my Rue will provide. This 'fitting' was way more involved than any other fitting I ever received at any bike shop. Bre even gave me the seat height and setback I'll need once my bike is setup. I know this may need adjusted, but it'll give me a good starting point.

KWalker ...sorry you don't agree with my build and my "ridiculous" components. I'm sure if you had the opportunity you'd pass on such foolish bike gear. Lol. Don't be a hater.

Thanks for the help everyone. There are definitely some helpful tips I'm going to explore.

I had a good fitter also fit me to a frame that was too big. Yah, it worked, but it wasn't optimal.

I would start with what I outlined above. I spent months trying to fix a bowing right knee and thats what I came up with. When I was hooked up to the Retul I displayed perfect knee tracing. Get some more supportive insoles (I rec. the Specialized red or blue) that actually lift your arch so they're supported and then put some varus wedges in one at a time until it feels better. Moving the cleats in also helped.

Tapeworm wrote:An experienced fitter with Retul can track lateral movement of the knee down to about 2mm I think. IF they are good they should be able to modify things to ensure that the issue is resolved.

I did this....my knees actually sweep out nice clean lines, just that my left knee points inwards and the right outwards, so I'm in a 'windswept' position. Apparently a twisted pelvis causing a leg length discrepancy. Consequently, I have pain in the right knee and require wedges. This helps but I think there's a muscle imbalance to add, so I'm still in a bit of discomfort...don't know about power and effeciency implications.

I'm going to see a sports osteopath next year backed up with the RETUL report.

You need to be more specific on where your knee hurts. Medial, anterior, under the patella, near the condial where the IT bands rolls over, etc, etc. It could be fit or previous injury, or an imbalance, a functional discrepancy, an actual discrepancy, or a combo of all the above. Most likely......... and I say this with hundreds of Retuls under my belt, it's your stance width or as people like to say "Q-factor". There could be a functional or actual discrepancy in length length, foot size, or hip symmetry all of which would cause knee "pain". Depending on what was causing it the "pain" will be in a different spot (thus the reason I asked you to be more specific).

Another thing I want to point out is the issue of wedges for alignment. I've made a lot of money fixing BG fits so take that for what it's worth. In my experience, and quite a few other fitters, forefoot varus and valgus (Metatarsus varus or valgus) is largely a huge problem (like you'd know before you ever turned a pedal) or a is a symptom it self of a the calcaneus rolling or moving. The short of the long; sticking a wedge under a cleat when you have a knee problem is akin to doctors handing out condoms and penicillin in 3rd world countries. They'll stop most stuff from spreading but it doesn't treat the root cause. I've, personally, had more success with alignment issues (hip, knee, forefoot) on guys when I put them in a foot bed like a Sidas Conformables (or something with a post) and get them off of wedges for alignment issues. 2nd, a lot of the BG fits I've corrected incorrectly diagnosed knee tracking issues as a forefoot alignment issue and treated it with shoes and insoles with a correction built in. Makes it easy to sell shoes huh. I'm not bagging on the Big S but really..... not everyone needs the correction. The Bontrager shoes come with awesome insoles by the way. Slapping a wedge under the cleat does little to fix the hip alignment issue with the foot as a whole. Further the BG fits do address stance width as a whole but put it much lower on the scale in order of importance. Why I'm not sure. I've been fit by Pruitt and one of the first things they did was correct my stance width and tell me NOT to use shims or wedges. Yet, having gone through the BG school, I came out thinking EVERYONE needed a wedge. Since their shoes have it built in no needs to fuss with a wedge, just sell them a BG shoe.

At any rate, we need more info and/or you need to go see a (good) fitter.

My pain is directly behind the knee. Feels like it's either right under the knee cap or deeper in the soft stuff. An orthopedic doctor thought it might be a bursa sac? Not sure if it is but that's where the pain is, if you are familiar with those.

My pain is directly behind the knee. Feels like it's either right under the knee cap or deeper in the soft stuff. An orthopedic doctor thought it might be a bursa sac? Not sure if it is but that's where the pain is, if you are familiar with those.

Thanks again

I'm not entirely against self-diagnosis, but this could be a very complex issue which I suspect only an excellent bike fitter could address. For example, my right knee does not track perfectly up/down (particularly when putting in efforts). Turns out I have a "non-visual sight problem".

That is, the signals that the eyes receive are interpreted by the brain. In my case, the signals that my brain is receiving from my left eye are being slightly misread. My spacial awareness is affected, so for example what I perceive to be standing (or sitting) straight is actually off-center. On the bike, this problem manifests itself as I drop my right hip, and my right knee tracks off center as a result. Weird huh? See a professional

I had what sounded like a very similar situation with my knee which i did due to a lack of flexibility and an over enthusiastic tt position.. then it just wouldnt shift and seemed to migrate its way around to the inside left of my knee. had a bike fit done (cyclefit) including wedges insoles toned training down for a while and all was ok.tikka